Selective Laser Trabeculoplasty as First-Line Treatment in Primary Open Angle Glaucoma: A Meta-Analysis
DOI:
https://doi.org/10.11594/ojkmi.v7i2.87Keywords:
Glaucoma, Primary open-angle glaucoma, selective laser trabeculoplastyAbstract
Introduction: For primary open-angle glaucoma (POAG), selective laser trabeculoplasty (SLT) is a non-invasive therapeutic approach that provides an alternative to conventional operations and medications. The effectiveness and safety profile of SLT as a primary treatment for newly diagnosed POAG were evaluated by a meta-analysis.
Methods: A systematic review and meta-analysis were performed using databases including PubMed, ScienceDirect, ProQuest, and Scopus from inception to March 2025, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Analyses were executed via Review Manager 5.4.1. Subgroup analyses were performed on SLT compared with medical therapy and categorized SLT as initial or adjunctive therapy.
Results: Out of twelve qualifying trials, 2.248 patients were combined. In newly diagnosed POAG, the results showed no significant differences in IOP reduction between SLT and topical medications as first line modality (Mean Difference (MD): 0.21, 95% CI 0.81 to 1.83, p=0.69, I2 = 70%); however, initial SLT performed better than adjunctive SLT (MD: 0.57, p=0.05, I2: 37%). Antiglaucoma drug use, glaucoma surgery rates, and ocular side effects were all markedly lower in the SLT group.
Conclusion: SLT has the potential to transform glaucoma management due to its enhanced efficacy, minimal adverse effects, reduced medication burden, and cost-effectiveness.
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Flaxman SR, Bourne RRA, Resnikoff S, Ackland P, Braithwaite T, Cicinelli MV, et al. Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. The Lancet Global Health [Internet]. 2017 Dec 1;5(12):e1221–34. Available from: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30393-5/fulltext
Shan S, Wu J, Cao J, Feng Y, Zhou J, Luo Z, et al. Global incidence and risk factors for glaucoma: A systematic review and meta-analysis of prospective studies. J Glob Health [Internet]. 14:04252. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544525/
Zhang N, Wang J, Li Y, Jiang B. Prevalence of primary open angle glaucoma in the last 20 years: a meta-analysis and systematic review. Sci Rep [Internet]. 2021 July 2;11:13762. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8253788/
Kementrian Kesehatan RI. Pedoman Nasional Pelayanan Kedokteran Tata Laksana Glaukoma. KEPUTUSAN MENTERI KESEHATAN REPUBLIK INDONESIA; 2023.
Li T, Lindsley K, Rouse B, Hong H, Shi Q, Friedman DS, et al. Comparative Effectiveness of First-line Medications for Primary Open Angle Glaucoma – A Systematic Review and Network Meta-analysis. Ophthalmology [Internet]. 2016 Jan;123(1):129–40. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695285/
Chi SC, Kang YN, Hwang DK, Liu CJ ling. Selective laser trabeculoplasty versus medication for open-angle glaucoma: systematic review and meta-analysis of randomised clinical trials. British Journal of Ophthalmology [Internet]. 2020 Nov 1;104(11):1500–7. Available from: https://bjo.bmj.com/content/104/11/1500
Gazzard G, Konstantakopoulou E, Garway-Heath D, Garg A, Vickerstaff V, Hunter R, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. The Lancet [Internet]. 2019 Apr 13;393(10180):1505–16. Available from: https://www.thelancet.com/article/S0140-6736(18)32213-X/fulltext
Francis BA, Ianchulev T, Schofield JK, Minckler DS. Selective Laser Trabeculoplasty as a Replacement for Medical Therapy in Open-Angle Glaucoma. American Journal of Ophthalmology [Internet]. 2005 Sept 1;140(3):524–5. Available from: https://www.ajo.com/article/S0002-9394(05)00270-9/abstract
Gedik S, Gulseren O. Effectiveness of Selective Laser Trabeculoplasty and its Safety on Corneal Endothelium in Patients with Primary Open Angle Glaucoma and Ocular Hypertension. Nigerian Journal of Clinical Practice [Internet]. 2022 Dec;25(12):2046–52. Available from: https://journals.lww.com/10.4103/njcp.njcp_560_22
Li X, Wang W, Zhang X. Meta-analysis of selective laser trabeculoplasty versus topical medication in the treatment of open-angle glaucoma. BMC Ophthalmology [Internet]. 2015 Aug 19 [cited 2025 Aug 13];15(1):107. Available from: https://doi.org/10.1186/s12886-015-0091-2
Chavez MP, Guedes GB, Pasqualotto E, Lopes LM, Ferreira ROM, de Souza ESMV, et al. Selective Laser Trabeculoplasty Versus Medical Therapy for the Treatment of Open Angle Glaucoma or Ocular Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of Glaucoma [Internet]. 2024 Dec [cited 2025 Aug 13];33(12):973. Available from: https://journals.lww.com/glaucomajournal/abstract/2024/12000/selective_laser_trabeculoplasty_versus_medical.9.aspx
Wong MOM, Lee JWY, Choy BNK, Chan JCH, Lai JSM. Systematic review and meta-analysis on the efficacy of selective laser trabeculoplasty in open-angle glaucoma. Survey of Ophthalmology [Internet]. 2015 Jan 1 [cited 2025 Aug 13];60(1):36–50. Available from: https://www.surveyophthalmol.com/article/S0039-6257(14)00131-3/abstract
Takusagawa HL, Hoguet A, Sit AJ, Rosdahl JA, Chopra V, Ou Y, et al. Selective Laser Trabeculoplasty for the Treatment of Glaucoma: A Report by the American Academy of Ophthalmology. Ophthalmology [Internet]. 2024 Jan 1;131(1):37–47. Available from: https://www.aaojournal.org/article/S0161-6420(23)00561-4/fulltext
Lewis S, Clarke M. Forest plots: trying to see the wood and the trees. BMJ [Internet]. 2001 June 16;322(7300):1479–80. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1120528/
Shi Y, Zhang Y, Sun W, Huang AS, Chen S, Zhang L, et al. 24-Hour efficacy of single primary selective laser trabeculoplasty versus latanoprost eye drops for Naïve primary open-angle glaucoma and ocular hypertension patients. Sci Rep [Internet]. 2023 July 27;13:12179. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10374636/
Lai JS, Chua JK, Tham CC, Lam DS. Five-year follow up of selective laser trabeculoplasty in Chinese eyes. Clinical & Experimental Ophthalmology [Internet]. 2004;32(4):368–72. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1442-9071.2004.00839.x
Katz LJ, Steinmann WC, Kabir A, Molineaux J, Wizov SS, Marcellino G. Selective Laser Trabeculoplasty Versus Medical Therapy as Initial Treatment of Glaucoma: A Prospective, Randomized Trial. Journal of Glaucoma [Internet]. 2012 Sept;21(7):460–8. Available from: https://journals.lww.com/00061198-201209000-00003
Philippin H, Matayan E, Knoll KM, Macha E, Mbishi S, Makupa A, et al. Selective laser trabeculoplasty versus 0·5% timolol eye drops for the treatment of glaucoma in Tanzania: a randomised controlled trial. Lancet Glob Health [Internet]. 2021 Oct 13;9(11):e1589–99. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8526362/
De Keyser M, De Belder M, De Groot V. Quality of life in glaucoma patients after selective laser trabeculoplasty. Int J Ophthalmol [Internet]. 2017 May 18;10(5):742–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437462/
McIlraith I, Strasfeld M, Colev G, Hutnik CML. Selective Laser Trabeculoplasty as Initial and Adjunctive Treatment for Open-Angle Glaucoma. Journal of Glaucoma [Internet]. 2006 Apr;15(2):124. Available from: https://journals.lww.com/glaucomajournal/abstract/2006/04000/selective_laser_trabeculoplasty_as_initial_and.9.aspx
Yong MH, Che Hamzah J. Selective laser trabeculoplasty vs. topical medications for step-up treatment in primary open angle glaucoma: comparing clinical effectiveness, quality of life and cost-effectiveness. Med J Malaysia. 2020 July;75(4):342–8.
Abdelrahman AM, Eltanamly RM. Selective Laser Trabeculoplasty in Egyptian Patients with Primary Open-Angle Glaucoma. Middle East Afr J Ophthalmol [Internet]. 2012;19(3):299–303. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401799/
Yener HI, Ozcimen M. Effectiveness of Selective Laser Trabeculoplasty as Initial or Adjunctive Treatment for Primary Open-Angle Glaucoma. Beyoglu Eye J [Internet]. 2020 Dec 28;5(3):199–204. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8784470/
Goosen E, Visser L, Sartorius B. Selective laser trabeculoplasty in primary open-angle glaucoma: Primary versus secondary treatment outcomes. African Vision and Eye Health [Internet]. 2016 Nov 3;75(1):6. Available from: https://avehjournal.org/index.php/aveh/article/view/338
Gračner T. Comparative study of the efficacy of selective laser trabeculoplasty as initial or adjunctive treatment for primary open-angle glaucoma. European Journal of Ophthalmology [Internet]. 2019 Sept;29(5):524–31. Available from: https://journals.sagepub.com/doi/10.1177/1120672118801129
Cochrane Methods Bias. The Risk Of Bias In Non-randomized Studies – of Interventions, Version 2 (ROBINS-I V2) assessment tool for follow-up studies). 2024.
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ [Internet]. 2019 Aug 28;l4898. Available from: https://www.bmj.com/lookup/doi/10.1136/bmj.l4898
Thelen P, Böhringer D, Keye P, Reinhard T, Lübke J. Selective Laser Trabeculoplasty after a Previous Glaucoma
Treatment. Biomedicines [Internet]. 2024 Sept 27;12(10):2212. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11505171/
Gulati V, Fan S, Gardner BJ, Havens SJ, Schaaf MT, Neely DG, et al. Mechanism of Action of Selective Laser Trabeculoplasty and Predictors of Response. Invest Ophthalmol Vis Sci [Internet]. 2017 Mar;58(3):1462–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5361453/
Li X, Wang W, Zhang X. Meta-analysis of selective laser trabeculoplasty versus topical medication in the treatment of open-angle glaucoma. BMC Ophthalmol [Internet]. 2015 Aug 19;15:107. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544808/
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